Two of California's largest health insurers have joined forces to create the most comprehensive electronic medical records network in the state.

Cal INDEX is designed to share patient records electronically among doctors and hospitals in real time. The new system, for instance, will allow emergency room doctors to pull up a comatose patient's medical records to see what medications he or she is allergic to.

But the decision by Blue Shield of California and Anthem Blue Cross to move the records of their combined 9 million customers into that system by year's end worries some privacy experts.

They say the network, for example, should allow consumers to "opt into" the system, not automatically be enrolled by the insurers.

"There are a lot of big pictures issues here that concern me," said Pam Dixon, executive director of the San Diego-based World Privacy Forum, renowned for its work in health care data security.

At a news conference Tuesday, Blue Shield President Paul Markovich outlined the benefits of Cal INDEX. He said it would provide a unified statewide source of integrated patient information to improve care, a seamless transition between health plans, and improved efficiency and reduced health care costs by helping providers accurately identify and manage the sickest, highest-risk patients.

The announcement was generally welcomed by California health officials and advocates for health technology after a federally funded effort to modernize health information known as Cal eConnect crumbled.

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Blue Cross and Anthem executives, who are asking other health insurers to join the system, stressed that Cal INDEX will adhere to strict privacy and security standards established by the federal and state governments.

"We know that patient privacy and security is just as important as having the most comprehensive medical records," said Mark Morgan, president of Anthem Blue Cross.

Any patient who does not want their health information shared with health providers or health plans on the exchange can choose not to participate, Morgan said.

Dixon, whose organization's website had tracked data breaches by hospitals and insurers around the country, said she supports such networks, but only if they are more tightly controlled.

She said she is particularly concerned about the amount of information that would be available to certain health care providers who don't need to see all of a patient's records.

"What we are dealing with is the entire record of the patient's history -- so, for example, your dentist can see your mental health record," Dixon said.

Lee Tien, staff attorney at the San Francisco-based Electronic Frontier Foundation, a nonprofit that defends civil liberties in the digital world, agreed with Dixon's concerns.

"These are very valid issues," Tien said. "How good is the accuracy? Who has access to the records? Who is it shared with? Are they going to use it for research?"

But supporters say the advantage of Cal INDEX, like other health information exchanges, is to deliver a much smoother customer experience.

Blue Cross and Blue Shield have contributed $80 million to fund the effort for the next three years to support initial integration of about 30 hospitals, physician groups and other health insurers around the state. After that, all participating insurers and health care providers will pay subscription fees.

Kaiser-Permanente, which already operates its own electronic medical records system, declined to comment on the development.

But Lloyd Dean, CEO of San Francisco-based Dignity Health System, said that Dignity will be on board.

Dean said the company entered into a much smaller network with a large physicians group in 2009 to coordinate patient information and share best practices. He said it succeeded "beyond anyone's expectations," improving outcomes for patients and saving money.